Cognitive behavioural therapy for co-morbid anxiety and depression in heart failure: a case report

Abstract

<jats:title>Abstract</jats:title> <jats:p>Heart failure increases the likelihood of an individual experiencing co-morbid anxiety and depression, which can affect their physical as well as mental health. There is a need to develop non-pharmacological interventions for the psychological consequences of heart failure. Evidence shows that cognitive behavioural therapy (CBT) can be helpful, but there is less clarity about CBT’s effectiveness for people with heart failure who have complex multi-morbid difficulties.</jats:p> <jats:p>This paper presents a case report of a man with heart failure. He was part of a research trial for cardiac resynchronisation therapy with defibrillation (CRT-D), after other physical procedures had been unsuccessful, and was experiencing severe anxiety and moderately severe depression. The intervention used was based on transdiagnostic CBT, provided at home over six sessions. Self-report measures were completed at each session and at 3-month follow-up. A measure of his use of clinical services was also carried out at pre-, post- and 3-month follow up. Post-intervention, the client showed non-clinical levels of depression and anxiety and these improvements were maintained at 3 months. Use of clinical services also reduced, with fewer admissions to hospital and fewer visits by specialist nurses and GPs.</jats:p> <jats:p>This case suggests that CBT, and particularly transdiagnostic CBT, can be helpful in reducing anxiety and depression in people with heart failure. Further work evaluating the impact on quality of life and the utility of this approach with a wider group of people with heart failure and psychological distress would be advantageous.</jats:p> <jats:sec id="S1754470X20000197_s1" sec-type="other"> <jats:title>Key learning aims</jats:title> <jats:p> <jats:list list-type="number"> <jats:list-item> <jats:label>(1)</jats:label> <jats:p>Depression and anxiety are prevalent in people with heart failure.</jats:p> </jats:list-item> <jats:list-item> <jats:label>(2)</jats:label> <jats:p>Cognitive behavioural therapy can be an effective intervention for reducing depression and anxiety in people living with heart failure.</jats:p> </jats:list-item> <jats:list-item> <jats:label>(3)</jats:label> <jats:p>There are benefits to integrating care with this population because they present with interlinked physical and psychological needs.</jats:p> </jats:list-item> </jats:list> </jats:p> </jats:sec>

The effectiveness of cognitive-behavioral therapy for heart failure patients: a narrative review

“…The study characteristics and results are summarized in Table 1. [17][18][19][20][21][22][23][24][25][26] Gary et al 17 conducted an RCT in stable New York Heart Association (NYHA) class II to III HF patients with depression. The effectiveness of a combined 12-week home-based exercise/CBT program was compared with CBT alone, exercise alone, and usual care.…”

Embedding the silver thread in all-age psychological services: training and supervising younger therapists to deliver CBT for anxiety or depression to older people with multi-morbidity

“…Depression and/or anxiety symptoms reduced from moderate to mild or asymptomatic on psychometric scales for all cases except for 'Ray' who scored above clinical cut-off for the duration of therapy (Birdsey, 2020). There were self-rated reductions in helplessness, memoryrelated worry and embarrassment (Richardson and Marshall, 2012), increased confidence and/ or activity (Harris and Hiskey, 2015;Richardson and Marshall, 2012), increased social contact (Walshe and Allen, 2020) and reduction in emergency bed days (Slaughter and Allen, 2020). It is interesting to speculate why Ray, the youngest of the case studies, receiving over three times as many sessions as any of the other case studies, showed the least symptom reduction.…”

“…Worry management, sleep hygiene, motivational self-statements and relapse prevention were also used in more than one case. Two of the case studies labelled their approach 'transdiagnostic CBT' (Slaughter and Allen, 2020;Walshe and Allen, 2020) and two combined CBT with compassion-focused therapy (Birdsey, 2020;Harris and Hiskey, 2015). All included between-session tasks.…”

“…In contrast to case illustrations from Gallagher-Thompson and Thompson (2010), none of the tCBT studies involved family members. For client 'B' (Slaughter and Allen, 2020), opportunities were provided to rehearse with the psychologist conversations that he wanted to have with his wife around reducing the protective behaviours she had put in place since the onset of his heart problems. Further adaptations involving others included briefing care home staff on how to reinforce alternative thoughts (Richardson and Marshall, 2012) and checking appropriateness of planned activities with members of the physical health team.…”

Transitioning Transdiagnostic CBT from Face-to-Face to Telephone Delivery During the Coronavirus Pandemic: A Case Study

“…This was found to be effective in reducing scores on scales of depression and anxiety and proved cost effective. Two case studies from the subsequently created PINC Service, have further indicated this efficacy (Slaughter & Allen, 2020;Walshe & Allen, 2020). As such it was felt that AB's presentation of comorbid anxiety and depression with an LTC that left her housebound, would be best served by PINC, as the preference was to deliver face-to-face therapy in the client's home.…”